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#Maintenance fluid calculator peds free#

100 ml/kg/24-hours = 4 ml/kg/hr for the 1st 10 kg.

The 24-hour number is often divided into approximate hourly rates for convenience, leading to the "4-2-1" formula. The Holliday-Segar nomogram approximates daily fluid loss, and therefore the daily fluid requirements, as follows:Įven though it is correct to think about fluid requirements on a 24-hour basis, the delivery pumps used in hospitals are designed to be programmed for an hourly infusion rate. Holliday and Segar determined how many calories a patient burns as a factor of weight. The diagram below is taken from their original publication "The maintenance need for water in parenteral fluid therapy", Pediatrics 1957.

Caloric expenditure, and therefore the water requirement, for the hospitalized patient can be estimated from the nomogram shown below.

This means that for every 100 kcal burned, the patient utilizes 100 ml of fluid.

Total daily water requirement to replace insensible and urinary water loss in the hospitalized patient is approximately 100 ml/100kcal/day.

Water loss (and therefore water requirement) is a function of caloric expenditure.

Holliday and Segar collated information from a number of studies, including their own, and concluded the following: This formula is based on the energy expenditure of healthy children, with 1 mL of fluid provided for each kcal expended, or 1500 mL/m2 per day. The commonly used method for approximating water loss (and therefore the water requirement) is based off of the Holliday-Segar nomogram. The resting energy expenditure in healthy children is vastly different from those with an acute disease and/or illness or after surgery. Thus, 40 to 60 meq of potassium per liter in one-half isotonic saline is preferred.” Mount et al.It is clinically useful to begin fluid therapy by estimating normal maintenance requirements using the estimated caloric expenditure method. “Although isotonic saline is often the initial replacement fluid used in treating diabetic ketoacidosis or nonketotic hyperglycemia, the addition of potassium will make this a hypertonic fluid (since potassium is as osmotically active as sodium), thereby delaying reversal of the hyperosmolality.

Thus, concurrent potassium replacement may be another indication for the use of one-half isotonic saline.” Kitabchi et al. “Potassium repletion affects the saline solution that is given, since potassium is as osmotically active as sodium. The timing of one-half isotonic saline therapy may also be influenced by potassium balance. When a patient is NPO and is on fluids, putting 20 KCL in it will give them about 40-50 per day. However, it is thought that 1600 to 2000 mg ( 40 to 50 milliequivalents ) per day for adults is adequate.” Mayo Clinic. “Because lack of potassium is rare, there is no RDA or RNI for this mineral. If you are planning to give more than 3-4 liters of normal saline, switch to LR because of the risk of “expansion acidosis”. For Volume Replacementįree water (orally, via NGT, via PEG tube)Įven 1/4 NS or D5 1/4 NS works for maintenance fluids The reason for giving dextrose (D5) is to prevent catabolism. Pre-procedure or NPO patient who is euvolemic: treat this patient like a surgical patient if the patient is going to be NPO for longer than 6-12 hours. NB: For the hypervolemic patient, avoid fluids at all cost.Īlso, patients who are healthy, can take po, and are admitted for an elective reason don’t need fluids.

#Maintenance fluid calculator peds free#

The patient who needs free water, e.g.The euvolemic patient who can take PO and has been admitted for an elective reason (e.g.The euvolemic patient who will be NPO (or take inadequate po).patient with sepsis, pneumonia, intractable nausea/vomiting, etc). When it comes to IV fluids, there are a few basic scenarios.

“Also, remember that dextrose gets almost immediately metabolized to water and CO2 when it enters the circulation so it is not osmotically active for too long.” Such patients need isotonic fluids (normal saline or Lactated Ringers).

As such, D5 1⁄2 NS is NOT appropriate for most medical patients who are hypovolemic. That’s why D5 1⁄2 NS is not an isotonic solution. Notice that sodium plays a bigger part in determining your osmolality than glucose. Serum osmolality = 2 (Na+) + Glucose/18 + BUN/2.8 Should you use NS, LR, or 1/2 NS as Maintenance fluids?